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Study Finds Cancer Diagnosis Linked to Insurance

ATLANTA — A nationwide study has found that the uninsured and those covered by Medicaid are more likely than those with private insurance to receive a diagnosis of cancer in late stages, often diminishing their chances of survival.

The study by researchers with the American Cancer Society also found that blacks had a higher risk of late diagnosis, even after accounting for their disproportionately high rates of being uninsured and underinsured. The study’s authors speculated that the disparity might be caused by a lack of health literacy and an inadequate supply of providers in minority communities. The study is to be published online Monday in The Lancet Oncology.

Previous studies have shown a correlation between insurance status and the stage of diagnosis for particular cancers. The new research is the first to examine a dozen major cancer types and to do so nationally with the most current data. It mined the National Cancer Data Base, which began collecting information about insurance in the late 1990s, to analyze 3.7 million patients who received diagnoses from 1998 to 2004.

The widest disparities were noted in cancers that could be detected early through standard screening or assessment of symptoms, like breast cancer, lung cancer, colon cancer and melanoma. For each, uninsured patients were two to three times more likely to be diagnosed in Stage III or Stage IV rather than Stage I. Smaller disparities were found for non-Hodgkins lymphoma and cancers of the bladder, kidney, prostate, thyroid, uterus, ovary and pancreas.

The study’s authors concluded that “individuals without private insurance are not receiving optimum care in terms of cancer screening or timely diagnosis and follow-up with health care providers.” Advanced-stage diagnosis, they wrote, “leads to increased morbidity, decreased quality of life and survival and, often, increased costs.”

The study cites previous research that shows patients receiving a diagnosis of colon cancer in Stage I have a five-year survival rate of 93 percent, compared with 44 percent at Stage III and 8 percent at Stage IV.

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“There’s evidence that not having insurance increases suffering,” said Dr. Otis W. Brawley, the American Cancer Society’s chief medical officer.

Not all cancer researchers believe that comprehensive screening and early detection is universally constructive. They argue that with certain cancers, like melanoma and prostate cancer, it can lead to misdiagnosis and overdiagnosis, with doctors identifying and treating tumors that may never cause serious problems. In some of those cases, surgery and drug therapies may actually shorten lives.

“Do these findings mean that patients without insurance are being diagnosed too late, or that insured patients are being excessively diagnosed?” said Dr. H. Gilbert Welch, a professor at Dartmouth who studies the usefulness of medical procedures. “And if it does mean that too many are being diagnosed late, we don’t know if it’s the problem of not being insured or a problem of cultural norms and patient education.”

Dr. Brawley said that the cancer society, the largest and wealthiest of the disease-centered philanthropies, received no more than 5 percent of its $1 billion in revenues from corporate donations, including some from medical suppliers and drug-makers that stood to profit from expanded screening. He said the group had rejected contributions from companies it considered directly connected to its research, and that he saw no conflict in the study on cancer and insurance.

The cancer society, Dr. Brawley said, has been conservative in its screening recommendations, which vary by cancer type and age. The study’s results, he said, would encourage broader screening for breast, colon and cervical cancers, where early detection has reduced death rates, but not necessarily for other cancers.

A version of this article appears in print on , on Page A10 of the New York edition with the headline: Study Links Diagnosis Of Cancer To Insurance. Order Reprints|Today's Paper|Subscribe